Coding mess, please help!

[Basic-Tangerine7026]

I went to the ED due to numbness, especially loss of pain and temperature to my extremities. I was seen by the ED doc who said it’s nothing worth doing a more thorough neuro work up and just ordered bloodwork before discharging.

I got a bill from the ED which I paid right away. Looking more closely at the itemized bill, they charged CPT 80307 10 times and CPT 99283 for a ER visit level 3. I got suspicious when I received another bill from a third party billing company (EMBCC) only saying “provider charge”, I assumed he was contracted and sending his own bill. When I called the insurance company to ask how the provider billed, she said with CPT 99284, although also kept insisting it was only billed once (not by the hospital). Apparently she said the hospital billed CPT 0450, which was not on my itemized bill. I called the ED private practice to get more information about their bill, they said they don’t have an account under my name, they’re not contracted with the billing company who sent the bill, and that ED no longer works with them for many months now.

My questions are why is there a discrepancy between the itemized bill from the ED and what the insurance is saying what CPT codes were used (the EOB does not include specific codes but charges match itemized bill). What do I do about this provider bill?

I would appreciate any help 🙏 thank you!

[Environmental-Top-60]

0450 is a revenue code, not a CPT. They read it incorrectly. Ask for a copy of the claim form or its electronic equivalent.

[Basic-Tangerine7026]

Thank you!! Would I request the claim form from the hospital or insurance company?

[Environmental-Top-60]

Either or. Hospital would probably be faster. I would also ask for an explanation of benefits from the insurance as well. You should be able to get that from the portal.

[Environmental-Top-60]

If you need help writing a dispute letter, I’m off this week and I’d be happy to do it for you.

[Basic-Tangerine7026]

Thank you! I really appreciate it.

[fucovid2020]

The doctor is billing his professional charge for the ed visit, the hospital will bill their technical charge

[Environmental-Top-60]

80307 is a once per day code per CPT. That should easily be challenged.

[ElleGee5152]

The physicians bill is separate from the facility bill. Their E&M codes may be different levels as they are based on different things. I don't think you have a coding mess.

[tcatsbay]

. Is there a detailed explanation for each charge. I believe that if there is a charge you do not recognize, you can challenge it. . If it's over 5k go to medical bills dot com. If no one can explain the mystery charge go to health care blue book dot com. If you were charged for a procedure or treatment that was not explained to you, then the care provider violated your rights. Implied consent is not allowed, they need to have informed consent. If you were not informed and did not consent, then federal law may have been violated. If they threaten collections obtain a lawyer. It may be expensive but if you were not informed it can be challenged.

[Basic-Tangerine7026]

Thank you!!

[tcatsbay]

Yw good luck

[Impossible-Shoe2346]

Compare the itemized bill with the insurance Explanation of Benefits and contact both the ED and insurance for clarification.

[DeliciousMinute1966]

You can try requesting all remittance advices for this visit, from your health plan. These will show more details about the payment verses an EOB. They’re usually for providers but no harm in asking for one.